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TABLE 3

Characteristics of Children With Third-Generation Cephalosporin-Resistant UTIs Who Had Escalation of Care While on Discordant Antibiotics

PatientAge, SexPresenting SymptomsEmpiric TherapyEscalation TypeReason for Escalation, Management, and Definitive Therapy Given
6 mo, female Fever, nausea and/or vomiting, abnormal urine odor, diarrhea Ceftriaxone (1 dose), oral Bactrim (1 dose), then cephalexin Admission The patient returned because of persistent fevers. She had a positive blood culture with E coli (E coli bacteremia with a ceftriaxone-susceptible strain), was treated with 3 d of ceftriaxone, and discharged on a course of cefixime. 
6 mo, male Fever, nausea and/or vomiting Cephalexin ED visit The patient returned because of persistent fever. He was given ceftriaxone and changed to cefdinir while awaiting susceptibilities; antibiotics were not changed after ED discharge. 
10 mo, female Fever, nausea and/or vomiting, poor oral intake Ceftriaxone (1 dose), then cephalexin ED visit The patient returned because of intolerance of oral medications and continued fevers. She was given another dose of ceftriaxone. When urine cultures were returned, the patient received 1 d of meropenem and a course of amoxicillin-clavulanate. 
12 mo, female Fever, diarrhea Cephalexin ED visit The patient returned because of persistent fever. She was given ceftriaxone and switched to ciprofloxacin after culture results returned. 
14 mo, male Fever, dysuria, abnormal urine odor Cefixime Admission The patient returned because of persistent fever, poor appetite, and irritability. He was treated with a course of ertapenem. 
14 mo, female Fever Cephalexin Admission The patient returned because of persistent fevers, vomiting, and poor oral intake. She was admitted for IV antibiotics, IV fluids, and was started empirically on ceftriaxone. After culture results returned, she was treated with a course of piperacillin-tazobactam. 
15 mo, female Fever, nausea and/or vomiting, abnormal urine odor Ceftriaxone (1 dose), then cefdinir ED visit The patient returned because of vomiting. She received ceftriaxone and ondansetron and was changed to ciprofloxacin after cultures returned. 
PatientAge, SexPresenting SymptomsEmpiric TherapyEscalation TypeReason for Escalation, Management, and Definitive Therapy Given
6 mo, female Fever, nausea and/or vomiting, abnormal urine odor, diarrhea Ceftriaxone (1 dose), oral Bactrim (1 dose), then cephalexin Admission The patient returned because of persistent fevers. She had a positive blood culture with E coli (E coli bacteremia with a ceftriaxone-susceptible strain), was treated with 3 d of ceftriaxone, and discharged on a course of cefixime. 
6 mo, male Fever, nausea and/or vomiting Cephalexin ED visit The patient returned because of persistent fever. He was given ceftriaxone and changed to cefdinir while awaiting susceptibilities; antibiotics were not changed after ED discharge. 
10 mo, female Fever, nausea and/or vomiting, poor oral intake Ceftriaxone (1 dose), then cephalexin ED visit The patient returned because of intolerance of oral medications and continued fevers. She was given another dose of ceftriaxone. When urine cultures were returned, the patient received 1 d of meropenem and a course of amoxicillin-clavulanate. 
12 mo, female Fever, diarrhea Cephalexin ED visit The patient returned because of persistent fever. She was given ceftriaxone and switched to ciprofloxacin after culture results returned. 
14 mo, male Fever, dysuria, abnormal urine odor Cefixime Admission The patient returned because of persistent fever, poor appetite, and irritability. He was treated with a course of ertapenem. 
14 mo, female Fever Cephalexin Admission The patient returned because of persistent fevers, vomiting, and poor oral intake. She was admitted for IV antibiotics, IV fluids, and was started empirically on ceftriaxone. After culture results returned, she was treated with a course of piperacillin-tazobactam. 
15 mo, female Fever, nausea and/or vomiting, abnormal urine odor Ceftriaxone (1 dose), then cefdinir ED visit The patient returned because of vomiting. She received ceftriaxone and ondansetron and was changed to ciprofloxacin after cultures returned. 

IV, intravenous.

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